Telemedicine visits in an established multidisciplinary central nervous system clinic for radiation oncology and neurosurgery (RADIANS) in a community hospital setting

OBJECTIVE

To determine the impact of telemedicine visits, compared to in-person visits, on patient satisfaction in an established community hospital-based multidisciplinary central nervous system (CNS) clinic.

METHODS

Telemedicine options - virtual visits and teleconferencing - were introduced in July 2020. Both radiation oncologist and neurosurgeon were simultaneously present for the telemedicine visit. Descriptive patient demographics, survey responses, and travel time and distance calculations were analyzed. Satisfaction score was compared to previously published data.

RESULTS

A total of twenty-five telemedicine visits (n=22 video; n=3 phone) were completed since July 2020. Patient demographics are as follows: mean age was 59 years (range=22-81), women (9) and men (16), repeat telemedicine visits n=10, malignant CNS disease (17) and benign disease (5). Mean one-way distance traveled was 165.07 miles (median=114; range=0.8-358). Mean roundtrip travel time was estimated at 5h 5min. Mean telemedicine visit duration was 15.3 mins (range=4-46). Mean patient satisfaction score for telemedicine visits was 4.84.

CONCLUSION

Patients who opted for the telemedicine visits found them just as effective as in-person visits, saving time and travel costs as well as ensuring patient safety during the current COVID-19 pandemic. The telemedicine visit platform facilitates the multidisciplinary clinic model and should be considered for more widespread utilization (Tab. 3, Fig. 1, Ref. 18).

Hemorrhage risk score and peripartum quantified blood loss

Background

Risk assessment tools are used by clinicians to predict which patients might have excessive bleeding. We studied the association between a peripartum hemorrhage risk assessment score using peripartum quantified blood loss (QBL) among those with vaginal deliveries who are often at lower risk for peripartum hemorrhage.

Methods

In this retrospective analysis of 1221 patients with term vaginal deliveries at a public New York City hospital, the Association of Women's Health, Obstetric and Neonatal Nurses (AWOHNN) risk assessment tool was used to categorize patients as low risk, medium risk, or high risk for postpartum hemorrhage.

Results

Low-risk scores were present in 925 (75.8%) patients, medium-risk scores in 268 (21.9%) patients, and high-risk scores in 28 (2.3%) patients. Outcome variables consisted of QBL (M = 213.8, SD = 215.00 mL), QBL ≥ 500 mL (n = 89, 7.3%), and ratio of postdelivery hematocrit to predelivery hematocrit (M = 0.9, SD = 0.08). High-risk score (B = 0.14, SE = 0.07, P = 0.04) but not medium-risk score was significantly associated with increased QBL as compared to low-risk score. Body mass index (BMI) measured as a continuous variable was significantly associated with increased QBL (B = 0.004, SE = 0.002, P = 0.049). However, BMI measured as a categorical variable using the AWOHNN cutoff score of >35 was not significantly associated with QBL. AWOHNN score was not significantly associated with QBL ≥ 500 mL or with the ratio of postdelivery hematocrit with predelivery hematocrit.

Conclusion

We recommend revising the AWOHNN measure to better reflect medium risk and to consider a different approach for BMI use as part of the AWOHNN risk score.